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Abstract
WHO and Health Action International (HAI) have developed a standardised method for
surveying medicine prices, availability, affordability, and price components in low-income
and middle-income countries. Here, we present a secondary analysis of medicine availability
in 45 national and subnational surveys done using the WHO/HAI methodology.
Data from 45 WHO/HAI surveys in 36 countries were adjusted for inflation or deflation
and purchasing power parity. International reference prices from open international
procurements for generic products were used as comparators. Results are presented
for 15 medicines included in at least 80% of surveys and four individual medicines.
Average public sector availability of generic medicines ranged from 29.4% to 54.4%
across WHO regions. Median government procurement prices for 15 generic medicines
were 1.11 times corresponding international reference prices, although purchasing
efficiency ranged from 0.09 to 5.37 times international reference prices. Low procurement
prices did not always translate into low patient prices. Private sector patients paid
9-25 times international reference prices for lowest-priced generic products and over
20 times international reference prices for originator products across WHO regions.
Treatments for acute and chronic illness were largely unaffordable in many countries.
In the private sector, wholesale mark-ups ranged from 2% to 380%, whereas retail mark-ups
ranged from 10% to 552%. In countries where value added tax was applied to medicines,
the amount charged varied from 4% to 15%.
Overall, public and private sector prices for originator and generic medicines were
substantially higher than would be expected if purchasing and distribution were efficient
and mark-ups were reasonable. Policy options such as promoting generic medicines and
alternative financing mechanisms are needed to increase availability, reduce prices,
and improve affordability.